• Journal of Korean Neurosurgical Society
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• v.53 no.5
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• pp.281-287
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• 2013

Objective : Pleomorphic xanthoastrocytoma (PXA) is a rare primary low-grade astrocytic tumor classified as WHO II. It is generally benign, but disease progression and malignant transformation have been reported. Prognostic factors for PXA and optimal therapies are not well known. Methods : The study period was January 2000 to March 2012. Data on MR findings, histology, surgical extents and adjuvant therapies were reviewed in twenty-two patients diagnosed with PXA. Results : The frequent symptoms of PXA included seizures, headaches and neurologic deficits. Tumors were most common in the temporal lobe followed by frontal, parietal and occipital lobes. One patient who died from immediate post-operative complications was excluded from the statistical analysis. Of the remaining 21 patients, 3 (14%) died and 7 (33%) showed disease progression. Atypical tumor location (p<0.001), peritumoral edema (p=0.022) and large tumor size (p=0.048) were correlated with disease progression, however, Ki-67 index and necrosis were not statistically significant. Disease progression occurred in three (21%) of 14 patients who underwent GTR, compared with 4 (57%) of 7 patients who did not undergo GTR, however, it was not statistically significant. Ten patients received adjuvant radiotherapy and the tumors were controlled in 5 of these patients. Conclusion : The prognosis for PXA is good; in our patients overall survival was 84%, and event-free survival was 59% at 3 years. Atypical tumor location, peritumoral edema and large tumor size are significantly correlated with disease progression. GTR may provide prolonged disease control, and adjuvant radiotherapy may be beneficial, but further study is needed.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.14 no.1
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• pp.37-41
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• 2014

Fabry disease is an X-linked disease caused by deficiency of the lysosomal enzyme alpha-galactosidase A. Affected males present anhydrosis, acroparesthesia and angiokeratoma, and subsequently cardiac, cerebral and renal complications are followed. Females and atypical variants show heterogeneous clinical symptoms. In 2001, two recombinant enzymes were approved for Fabry disease: agalsidase alpha and agalsidase beta. Since the introduction of enzyme replacement therapy (ERT), the number of long-term follow-up studies has been reported. Long-term ERT showed effectiveness on renal function in patients with chronic kidney disease, decrease or stabilization of left ventricular mass, and improvement of pain and quality of life. However, there were limited effects on cerebrovascular events and their mortality. Current literatures on the clinical effect of ERT have reported limited datain adult patients who have already advanced disease. Therefore, further study for pre-symptomatic patients and atypical variants is needed to verify the impact of ERT. This review summarized recent progresses in ERT and limitations of long-term effect of ERT in patients with Fabry disease.

• Journal of Korean Dental Science
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• v.5 no.2
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• pp.68-76
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• 2012

Purpose: The headache is a symptom that various somatic or non-somatic disorders gives an effect to head and neck system. The neck and the shoulder pain is a common muscle pain that can not control and bothers the patient after chronic state. The headache and the neck and the shoulder muscle pain are treated with various conventional treatment methods. But, there are cases that symptoms did not resolve or increased in some clinical cases. And generally, the result of temporomandibular disorders (TMD) treatment is good. But, despite of a normal treatment was performed for TMD, there are cases that TMD symptoms did not resolved in clinical cases. In template clinic of Soonchunhyang University Bucheon Hospital, co-operative neurophysiologic treatment of Department of Neurosurgery and Dentistry are done for patients, who had head and neck pain or atypical symptoms that did not treated with various conventional treatment method such as surgery or medication etc. Materials and Methods: Four hundred fifty one patients who have treated in the template clinic, Soonchunhyang University Bucheon Hospital, from January of 2006 to December of 2008 were subjected in this study. Result: Overall average age was 31.9 years old. Ratio of numbers is 74.3% in female and 25.7% in male. The success rate of treatment in TMD symptom was 89.9%, in headache was 88.8%, in muscle pain was 81.6%. Statistically significance of differences visual analogue scale evaluation between before and after had been treated patients who have over average grade headache was calculated by paired t-test. P<0.05 was considered significant. Conclusion: We suggest the template appliance can be attempted for cases whose headache, the neck and the shoulder muscle pain and TMD are not resolved with various conventional treatment methods.

• Clinical and Experimental Pediatrics
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• v.48 no.1
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• pp.63-67
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• 2005

Purpose : Henoch-$Sch{\ddot{o}}nlein$ purpura(HSP) is a systemic vasculitis, characterized by cutaneous palpable purpura, gastrointestinal(GI) symptoms, arthritis and renal involvement. In general, the prognosis is determined by GI complication as well as the severity of nephritis. In this study, we analyzed the statistical relationship between the GI symptom and other clinical findings for assessing the prognosis, and evaluated abdominal ultrasonographic findings for early diagnosis of this disease with atypical clinical presentation and early detection of serious GI complications. Methods : One hundred seventy seven patients with HSP in the Department of Pediatrics, Wonkwang University Hospital from January 1994 to June 2004, were enrolled. We retrospectively analyzed charts about clinical and abdominal ultrasonographic findings, and classified our patients into two groups(GI-Sx(-), GI-Sx(+)) for statistical analysis. Results : The ratio of female to male is 1.5 : 1. The peak age incidence was five to eight years in 95 cases(53%). The GI symptoms appeared in 117 cases(66%), which include abdominal pain 115 (98 %), tenderness 45(38%), nausea and vomiting 35(30%), bloody stool 10(8.5%), diarrhea four(3.4%), rebound tenderness four(3.4%), and also intussusception and appendicitis were complicated in five and two cases respectively. GI-Sx(+) group had an increased risk of renal involvement and relapse than the GI-Sx(-) group. But there were no relationships about sex and age incidence, or other clinical and laboratory findings between two groups. Ultrasonographic findings in 98 patients with GI symptoms included small bowel thickening in 70 cases(71%) in which duodenum, jejunum and ileum were involved in 71%, 45.7%, 40% respectively, small bowel dilatation in 41 cases(42%), lymph node swelling in 46 cases(47%), and ascites in 25 cases(25.5%). Conclusion : GI symptoms in patients with HSP suggested increased risk of renal involvement and relapse. Abdominal ultrasonography could be helpful in the early diagnosis on atypical clinical presentation and early detection of serious GI complication in these patients.

• Korean Journal of Psychosomatic Medicine
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• v.29 no.2
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• pp.95-101
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• 2021

Patients complaining with somatic symptoms are very common in clinical practice, and are often consulted to medical department. But it is difficult to treat well. The treatment of somatic symptom disorder is multi-modal as none of the methods on their own provide a satisfactory outcome. The treatment of somatic symptoms disorders is complicated by lack of boundary, conceptual clarity, and overemphasis on psychosocial causation and effectiveness of psychological treatments. In clinical practice all classes of psychotropics are used to treat somatic symptoms disorder. Drugs such as tricyclic antidepressants, serotonin reuptake inibitors(SSRI), serotonin and noradrenalin reuptake inhibitors (SNRI), atypical antipsychotics are studied. The evidence indicates that these drugs are effective in somatic symptom disorders. All classes of antidepressants seem to be effective against somatic symptom disorders. SSRIs are more effective against hypochondriasis and body dysmorphic disorder, and SNRIs appear to be more effective than other antidepressants when pain is predominant. The author suggest that psychiatrists should know how to treat patients complaining with somatic symptoms by using not only psychotherapeutic approach but also pharmacological treatment. It will be helpful to reduce suffering and increase quality of life of these patients.

• Korean Journal of Biological Psychiatry
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• v.5 no.2
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• pp.253-262
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• 1998

Objectives : Risperidone, an atypical antipsychitics which blocks both dopaminergic and serotonergic receptors, have a good response to the negative symptoms as well as positive symptoms, and improve cognitive dysfunction of schizophrenic patients. Furthermore, it has few extrapyramidal side effects and tardive dyskinesia. Although it had been reported that the atypical antipsychotics have less effect on prolactin(PRL) than the classical antipsychotics, we could experience PRL-associated symptoms such as amenorrhea, galactorrhea and hyperprolactinemia in practice. Therefore, we tried to identify the sex differences of risperidone-induced hyperprolactinemia, to evaluate factors affecting PRL levels, and to know the association between cognitive disorders and PRL. Methods : The baseline levels of PRL and TSH prior to risperidone administration were measured by enzyme immunoassay method for 50 patients(25 ma-les and 25 females) admitted with schizophrenia, schizoaffective disorder or schizophreniform disorder according to the DSM-IV classification, and the measurements of PRL were repeated on the 2nd and the 4th wks of risperidone administration. Concomitantly, the severity of psychotic symptoms using CGI, BPRS and PANSS, and the cognitive dysfunction using PANSS-CF were assessed prior to, on the 2nd and the 4th wks of risperidone administration. The PRL and TSH levels of 54 healthy controls(29 males and 25 females) who had no medical, neurological and psychiatric illnesses were also evaluated. Furthermore, the correlation with the psychiatric diagnosis, education, age, sex, duration of illnesses, risperidone dosage, duration of risperdone administration, TSH concentration, cognitive function, severity of psychotic symptoms were also identified. Results : 1) The baseline PRL levels of female schizophrenics($74.3{\pm}49.6ng/ml$) were significantly(p<0.005) higher than those of males($36.3{\pm}24.6ng/ml$), which were significantly(p<0.0001 respectively) higher than those of controls(females $16.9{\pm}6.1ng/ml$, males $13.3{\pm}4.9ng/ml$). The PRL levels measured on the 2nd wks(females $133.7{\pm}47.8ng/ml$, males $56.9{\pm}23.6ng/ml$) and on the 4th wks(females $146.1{\pm}45.9ng/ml$, males $70.0{\pm}31.5ng/ml$) after risperidone administration were significantly(p<0.0001 respectively) higher in females. The mean dosages of risperidone on the 2nd wks were $3.8{\pm}1.7mg$(2-6mg) for the females and $4.0{\pm}1.6mg$(2-6mg) for the males, and on the 4th wks were $4.5{\pm}2.1mg$(2-8mg) for the females and $5.4{\pm}2.2mg$(2-8mg) for the males. 2) The rise of PRL levels were positively correlated with increased risperidone dosage in males(${\gamma}$=0.307 on the 2nd wks and ${\gamma}$=0.280 on the 4th wks), while they were not correlated with dosages in females. For the females, the PRL levels were negatively correlated(${\gamma}$=-0.320) with decrease of TSH concentration. The baseline PRL levels were not correlated with age, education, duration of illnesses, psychopathology, cognitive disorders in both males and females, while it was negatively correlated with TSH levels only in females(${\gamma}$=-0.320). 3) The cognitive dysfunction was not correlated with PRL levels in males, while PANSS-CF scores were negatively correlated with PRL levels(${\gamma}$=-0.220 on the 2nd wks and ${\gamma}$=-0.366 on the 4th wks) in females. The psychopathology was positively correlated with cognitive dysfunction in both males and females. Therefore, the risperidone-induced cognitive improvement seemed to be correlated with improvement of psychopathology in both males and females, and with increase in PRL levels only in females. Conclusions : The fact that the serum PRL levels of schizophrenics were higher than those of controls, especially in females suggested that it could be related with risperidone dosage in males and with primary pathological process in females. The risperidone-associated cognitive improvement seemed to be related with general improvement of psychopathology as well as the rise of PRL levels especially in females. The facts that the effect of risperidoneinduced hyperprolactinemia and the cognitive function were more in females suggested that somewhat different mechanisms could be exerted on them.

• Sleep Medicine and Psychophysiology
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• v.6 no.1
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• pp.46-51
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• 1999

Objectives: Patients with premenstrual dysphoric disorder(or PMDD) have impairments of the social, occupational or academic function due to psychological or somatic symptoms, which have the characteristic pattern of symptom exacerbation in the week before menses begin and remission shortly after the onset of menses. In the chronobiological view, many researchers have assumed that the etiology of PMDD is the advanced circadian rhythm. It has been suggested that light has a therapeutic effect on PMDD, because evening light results in phase delay of circadian rhythm through the biochemical changes including melatonin. Methods: The authors investigated the therapeutic effect of light therapy on four patients with prospectively diagnosed PMDD by DSM-IV criteria using clinical psychiatric interview, Premenstrual Assessment Form(PAF) and Daily Rating Form(or DRF). In the evening(6:30pm-8:00pm), the 2,500 lux light administered for seven consecutive days during the symptomatic late luteal phase of menstrual cycle. Beck Depression Inventory(or BDI), Hamilton Rating Scale for Depression(or HAM-D), Spielberg State Anxiety Inventory(or SA), and DRF were evaluated before and after seven days of light therapy. Results: Premenstrual symptoms of PMDD could be effectively treated with the evening bright light therapy, especially in PMDD patients with atypical symptoms. In addition, the light therapy seemed to more effective on the psychologic symptoms than the somatic symptoms of PMDD. There was no significant side-effect of light therapy, except the transient and mild eye-strain in one case. Conclusions: In spite of the results of limited data from our clinical trial, the authors suggest that the potential use of light therapy as an alternative to the pharmacological management of patients with PMDD.

• Journal of The Korean Society of Clinical Toxicology
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• v.10 no.1
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• pp.33-36
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• 2012

Opioids are the one of the most commonly used drugs to control cancer pain all over the world. But, we should not overlook the potential risk of opioid intoxication because they have well-known detrimental side effects. The opioid intoxication can be diagnosed thorough various clinical manifestations. The altered mental status, respiratory depression, and miosis is very representative clinical features although these symptoms don't always appear together. Unfortunately the opioid-toxidrome can be varied. A 42 years old man came to our emergency room after taking about 900 mg morphine sulfate per oral. He was nearly alert and his respiration was normal. Even though his symptoms didn't deteriorated clinically, serial arterial blood gas analysis showed increase in PaCO2. So we decided to use intravenous naloxone. Soon, he was fully awaked and his pupils size was increased. After a continuous infusion of intravenous naloxone for 2 hours, PaCO2 decreased to normal range and his pupil size also returned to normal after 12 hours. Though the levels of serum amylase and lipase increased slightly, his pancreas was normal according to the abdominal computed tomography. He had nausea, vomit, and whole body itching after naloxone continuous infusion, but conservatively treated. We stopped the continuos infusion after 1 day because his laboratory results and physical examinations showed normal. As this case shows, it is very important to prescribe naloxone initially. If you suspect opioid intoxication, we recommend the initial use of naloxone even though a patient has atypical clinical features. In addition, we suggest intranasal administration of naloxone as safe and effective alternative and it's necessary to consider nalmefene that has a longer duration for opioid intoxication.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.203-209
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• 2008

Purpose: To emphasize the importance of considering tuberculosis in atypical cases of foot and ankle by reporting clinical results of those cases. Materials and Methods: Seven cases which were diagnosed as tuberculosis around foot and ankle from March 1996 to June 2007 were included. We reviewed initial impressions, the time to be diagnosed, clinical symptoms, laboratory findings, radiological findings and the clinical results and complications. Results: We followed up at least 6 months ($6{\sim}24$ months) after surgery in all cases. Initially 2 cases had been diagnosed as cellulitis, 4 cases as chronic osteomyelitis, and 1 case as an ankle instability. Tuberculosis was diagnosed after biopsy in all cases. Mean duration of symptom was 15 months ($6{\sim}36$ months) except in infants. There were various radiologic manifestations such as osteopenia, bony erosion or destruction and cystic changes. Symptoms were relieved in all cases within 4 months with chemotherapy followed by surgical biopsy, except one ankle which had been misdiagnosed as ankle instability and joint destruction was developed after modified Brostrom surgery. Conclusion: It is important to perform a surgical biopsy for diagnosis and proper management even with a faint suspicion on tuberculosis in foot and ankle. And in case of need, when surgical biopsy is performed, curettage procedure may help to improve clinical result.

• The Plant Pathology Journal
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• v.23 no.3
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• pp.193-202
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• 2007

Typical susceptible symptoms of the bacterial pustule disease caused by Xanthomonas axonopodis pv. glycines are pustule and chlorotic haloes that usually occur in leaves of Glycine max plants. The soybean genotype 'PI96188' showed an atypical response to all tested races X. axonopodis pv. glycines, accompanied with necrosis without chlorotic haloes on the underside of the necrotic symptoms. X. axonopodis pv. glycines 8ra grew to levels from 10 to 100 fold lower on PI96188 than on susceptible cultivar Jinjoo1, but 10-fold higher than on the resistant cultivar CNS. The chlorophyll content in PI96188 leaves remained unchanged until 12 days after bacterial infection. Ultrastructural observation showed that the infected leaf cells of PI96188 had intact normal chloroplasts compared to those of the susceptible cultivar Jinjoo1. Chloroplast degradation or the absence of chloroplasts in cells of the infected tissues was observed in Jinjoo1. Senescence-related ACS7 gene was significantly induced in PI96188 compared to those in Jinjoo1 at 2 days after inoculation. While photosynthesis-related rbcS gene showed the dramatic change in Jinjoo1, this gene was constitutively expressed in PI96188. However, expression of the defense-related genes, such as peroxidase and isoflavone synthase in the infected PI96188 leaves was similar to that in Jinjoo1. Together, these results suggest that the novel necrotic symptom in PI96188 is a kind of resistant response different from a typical hypersensitive response in the resistant genotypes.